Septated cystic tumors of the pancreas: is it possible to treat them by endoscopic ultrasonography-guided intervention?
OBJECTIVE
Endoscopic ultrasonography (EUS)-guided intervention has recently been tried in the treatment of cystic tumors of the pancreas. Factors that can influence the treatment response include cyst wall thickness and the presence of septation and mural nodules. This study aimed to evaluate the effectiveness of EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) in the treatment of septated cystic tumors of the pancreas.


METHODS
Ten patients with oligolocular septated cystic tumors underwent EUS-EP and the treatment response was analyzed by measuring cyst volume before and more than 6 months after treatment.


RESULTS
The 10 patients comprised 7 women and 3 men, of mean age 38.4 years (range 22-54 years). Median tumor diameter was 29.5 mm (range 20-68 mm), while median tumor volume was 5.07 ml (range 1.51-68.74 ml). Median carcinoembryonic antigen and amylase concentrations in the cyst fluid were 39.2 ng/ml (range 1-8,190 ng/ml) and 115.5 U/L (range 5-75,633 U/L), respectively. Three tumors were diagnosed as mucinous cystic neoplasms, four as serous cystadenomas, and three as indeterminate cysts. Median tumor volume had decreased to 0.54 ml (range 0.00-12.42 ml). Complete resolution was achieved in six patients and partial resolution in two, whereas two patients had persistent cysts. Two patients with persistent cysts underwent surgical resection, and focal remnant neoplastic epithelial lining was observed on the resected specimens.


CONCLUSIONS
EUS-EP resulted in complete resolution in 6 of 10 patients with septated cystic tumors. Careful patient selection and tailored intervention are required to maximize the therapeutic efficacy of this procedure.
Oh
Hyoung-Chul
HC
Department of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.
Seo
Dong Wan
DW
Kim
Song Cheol
SC
Yu
Eunsil
E
Kim
Kyungeun
K
Moon
Sung-Hoon
SH
Park
Do Hyun
DY
Lee
Sang Soo
SS
Lee
Sung Koo
SK
Kim
Myung-Hwan
MH
D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D019160:Endosonography; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome
D000972:Antineoplastic Agents, Phytogenic; D000431:Ethanol; D017239:Paclitaxel